Assignment; Assessing and Treating Vulnerable Population for Depressive Disorders

Assignment; Assessing and Treating Vulnerable Population for Depressive Disorders

Assignment; Assessing and Treating Vulnerable Population for Depressive Disorders

Mental illnesses are known to negatively impact patients in various dimensions, hence a need for appropriate care and management. Among such mental illnesses are mood disorders which have been shown to negatively affect human life substantially. Mood disorders can make it difficult for patients to perform the simplest of basic tasks needed for daily living and also impact their families (Charles et al., 2021). The appropriate management of mood disorders heavily depends on accurate diagnosis and correct prescriptions. However, there are vulnerable groups whose diagnosis and treatment come with complications. For example, the pediatric population is vulnerable, and when they experience mood disorders such as depression, the process of assessment, diagnosis, and treatment can be complex as they may have different symptoms and additional symptoms as compared to adults. In addition, children also metabolize medications differently from adults, implying that careful medication choices should be made. Therefore, the purpose of this assignment is to formulate a patient medication guide for the treatment of depressive disorder among children as a vulnerable population.

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Depressive Disorder: Causes and Symptoms

            Depression is a mood disorder that makes a patient experience persistent feelings of loss of interest in activities once cherishes and sadness. The condition can also make a patient experience complication with sleeping, eating, memory, and thinking. There are various types of depressive disorders, including major depressive disorder, persistent depressive disorder, disruptive mood dysregulation disorder, and depression with symptoms of psychosis, among others (Mullen et al., 2018).

Causes

While there is no specific cause of the depressive disorder, several factors can lead to the condition. For example, an imbalance of neurotransmitters such as dopamine and serotonin has been shown to lead to depression. Genetics also play a role in depression; for example, if an individual has a first-degree relative with depression, then the individual has up to three times the possibility of developing depression as compared to the general population (Mullen et al., 2018). Stressful life events can also cause depression. For example, tough experiences such as lack of support, isolation, divorce, trauma, and the death of a loved one can all lead to depression. Other medical conditions, such as diabetes and chronic pain, can cause depression. Some medications are also known to lead to depression as a side effect.

Symptoms

            A patient with depression can present with several symptoms. For example, a person may display suicidal thoughts or thoughts of self-harm, physical complications such as sexual dysfunction, stomachache, and headache. Other symptoms may also include having difficulties remembering things, in decision making and concentrating, having low energy, hypersomnia or insomnia, eating too much leading to weight gain or eating too little, leading to weight loss, and easily getting frustrated or irritated (Kennedy et al.,2022). Children may be more irritable, while adults can have feelings of sadness. An individual may also stop enjoying the things they used to enjoy or things that used to bring them joy.

Diagnosis of Depression in Children and Why Children Are Vulnerable

            As earlier indicated, successful treatment and management of depression heavily hinge on the accuracy of diagnosis. Therefore, the process of diagnosis should appropriately be accomplished. Depressive disorder is diagnosed among children in various ways. An appropriate diagnosis of depression requires that the practitioner combines the patient’s mental health history, medical history, and symptoms to help narrow down the type of depressive disorder (Maurer et al., 2018). In the pediatric population, the first step is to perform a comprehensive medical examination and evaluation of the patient’s cognitive and mental processes. In some cases, laboratory tests may be needed to rule out other conditions that may mimic depression, such as seizure disorders, kidney or liver disorders,

The next step in the diagnosis entails the exploration of the psychiatric history by examining the developmental history and the symptoms. In addition, social and family history, including the school environment, mental illness, and other factors that may cause overwhelming stress, are all explored in this stage. The practitioner then takes the child through direct interviews covering various formats, such as open-ended questions, and observing the child interact with other children and parents (Maurer et al., 2018). The child can then be diagnosed with depressive disorder if they show at least five depressive symptoms every day for at least two weeks according to the DSM V criteria.

Children are considered a vulnerable group since, in most cases; they may not have the capacity or capability to explain what they are feeling or to explain their symptoms. In addition, they may not be able to identify various triggers, such as stress triggers which can lead to depression; hence they need to take care of them. This population is also vulnerable since they metabolize some medications completely differently from how adults metabolize them (Maurer et al., 2018). Therefore, some medications can have far more side effects or impacts on them. As such, a lot of caution should be taken when prescribing their medications.

Medication Treatment Options

            Apart from the psychotherapy approach, which has gained attention in recent years, medications have been used to effectively treat depression. Antidepressants are a class of medications that have been approved to be used in treating depressive disorders among children, adolescents, and adults (Selph& McDonagh, 2019). However, careful monitoring of these medications should be done when used among children. The FDA has approved several medications to be used in treating major depressive disorders, as shown in the table below.

 Fluoxetine has been widely used to treat depression among children. It belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs). This medication has various benefits, such as having fewer side effects as compared to medications used in treating depressive disorder. It also increases serotonin levels in the brain, which then enables the individual to have a good mood and sound sleep (Selph& McDonagh, 2019). However, there are various risks associated with this medication. The risks include possible allergic reactions, reduced sodium, seizures, slow heartbeat, swollen gland, painful or prolonged erections, and serotonin syndrome. Other risks include decreased appetite, throwing up, stomach upset, diarrhea, suicidality, and constipation. As earlier highlighted, this medication has been approved by the FDA to be used among children of at least eight years old.

Why It is Important to Monitor Labs and Comorbid Medical Issues

            Fluoxetine, just like other medications, needs monitoring. In particular, when children use this medication, careful monitoring of various aspects should be done. There is a risk of suicidality among children; hence close monitoring is required. Therefore, as part of the FDA recommendations, a weekly follow-up should be done for up to four weeks to help monitor the adverse events and suicide risks (Yan & Goldman, 2019). In addition, there is a need to periodically monitor the child’s weight and height when they have been given fluoxetine. Even though no routine laboratory testing is required for healthy patients, liver function tests and blood glucose tests may be ordered for patients with comorbidities. ECG assessment is also carried out for those with risk factors for ventricular arrhythmias and QT prolongation.

Special Considerations and Follow Up

            Special considerations should be taken when using fluoxetine among the pediatric population. This medication is only available on prescription; therefore, the parents have to give informed consent since children do not have this capacity (Yan & Goldman, 2019). The practitioner should also consider cultural aspects. For example, an inquiry should be made if there are any cultural beliefs from the child’s background that may bar the use of this medication. The legal considerations include ensuring that the right prescription is given to the patient for effective treatment. For example, the prescription for children should be used and not for adults.

Follow Up and Example of Prescription

Follow-ups are important, especially among this population, whenever they use this medication. The follow-up should be done in the community health center once a week for four weeks to ensure that the child is not developing adverse reactions and not having suicidal thoughts (Yan & Goldman, 2019). The patient will also need a proper prescription to be provided to the patient and also transmitted to the pharmacy. For example, a proposer prescription should include the medication name, date of issue, patient’s name and address, patient’s date of birth, the clinician’s name and address, the drug strength, dosage form, and quantity prescribed. Examples of prescription include: Fluoxetine (10 mg, PO, for 7 days before doubling the dose); Escitalopram (10 mg PO qDay; may increase to 20 mg/day after 1 week); Duloxetine (30 mg PO qDay),

Conclusion

A medication guide plays a critical role in educating individuals such as patients and caregivers. Therefore, a medication guide for the treatment of depressive disorders has been formulated. In particular, the write-up has focused on fluoxetine, an antidepressant used in the treatment of children as well as adults.

References

Charles, N. E., Strong, S. J., Burns, L. C., Bullerjahn, M. R., & Serafine, K. M. (2021). Increased mood disorder symptoms, perceived stress, and alcohol use among college students during the COVID-19 pandemic. Psychiatry Research, 296, 113706. https://doi.org/10.1016/j.psychres.2021.113706

Kennedy, S. H. (2022). Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues In Clinical Neuroscience. https://doi.org/10.31887/DCNS.2008.10.3/shkennedy

Maurer, D. M., Raymond, T. J., & Davis, B. N. (2018). Depression: screening and diagnosis. American family physician, 98(8), 508-515. https://pubmed.ncbi.nlm.nih.gov/30277728/

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275

Selph, S., & McDonagh, M. S. (2019). Depression in children and adolescents: evaluation and treatment. American family physician, 100(10), 609–617. https://www.aafp.org/pubs/afp/issues/2019/1115/p609.html

Yan, T., & Goldman, R. D. (2019). Time-to-effect of fluoxetine in children with depression. Canadian Family Physician, 65(8), 549–551. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693597/

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Mood disorders can impact every facet of a human being’s life, making the most basic activities difficult for patients and their families. This was the case for 13-year-old Jeanette, who was struggling at home and at school. For more than 8 years, Jeanette suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues.

As a PNP working with pediatric patients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies

guide for adolescents, drug: Fluoxetine***

For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your patient guide, include discussion on the following:

Depressive disorder causes and symptoms

How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable

Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice

Medication considerations of medication examples prescribed (see last bullet item)

What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring

Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health

Where to follow up in your local community for further information

provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Resources : psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

Chapter 6, Mood Disorders and the Neurotransmitter Networks Norepinephrine and y-Aminobutyric Acid (GABA) (pp. 244-282)

Chapter 7, Treatments for Mood Disorders: So-Called “Antidepressants” and “Mood Stabilizers” (pp. 283-338)

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

Howland, R. H. (2008a). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. https://doi.org/10.3928/02793695-20080901-06

Howland, R. H. (2008b). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21–24. https://doi.org/10.3928/02793695-20081001-05

Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-textbook of child and adolescent mental health. https://iacapap.org/_Resources/Persistent/45bdffb25befc353c9f61988e82105029504ab85/A.7-Psychopharmacology-2019.1.pdf

Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scale—Revised. Western Psychological Services.

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. https://doi.org/10.1002/da.22171

Yasuda, S. U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

Review the following medications:
amitriptyline

bupropion

citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine

escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine

mirtazapine

nortriptyline

paroxetine
selegiline

sertraline
trazodone

venlafaxine
vilazodone
vortioxetine